Aparato Digestivo, Complejo Asistencial Universitario de Salamanca, España.
Aparato Digestivo, Complejo Asistencial Universitario de Salamanca.
Rev Esp Enferm Dig. 2021 Aug;113(8):591-596. doi: 10.17235/reed.2020.7547/2020.
there is a rising number of patients receiving antiplatelet and anticoagulation therapy who require endoscopic retrograde cholangiopancreatography (ERCP), probably due to the increased morbidity of older patients. Considering the increasing use of direct oral anticoagulants (DOACs), this study aimed to determine the influence of these factors on the possibility of hemorrhage after ERCP in our center.
data were collected from all the examinations carried out in 2017 and 2018, which included 797 examinations on 588 patients. Collected data included personal history of the patients, results of the test and follow-up.
the percentage of post-ERCP bleeding was 4.6 % (n = 37). With regard to the severity, the bleeding was mild in 21.6 % (n = 8) of the cases, moderate in 59.5 % (n = 22) and severe in 18.9 % (n = 7). Previous cardiopathy antiplatelet therapy, anticoagulation therapy, treatment with DOACs, having a pancreatic stent and lithiasis removal doubled the risk of bleeding after ERCP. Having a sphincterotomy increased the risk by over five-fold.
according to the multivariate analysis, a statistically significant increase of bleeding among patients treated with DOACs was observed compared to patients who received anticoagulation with acenocoumarol or low-molecular-weight heparins (LMWH).
由于老年患者发病率增加，接受抗血小板和抗凝治疗的患者需要进行内镜逆行胰胆管造影（ERCP）的人数不断增加。鉴于直接口服抗凝剂（DOAC）的使用越来越多，本研究旨在确定这些因素对我们中心 ERCP 后出血可能性的影响。
从 2017 年和 2018 年进行的所有检查中收集数据，共纳入 588 名患者的 797 次检查。收集的数据包括患者的个人病史、检查结果和随访情况。
ERCP 后出血的百分比为 4.6%（n=37）。就严重程度而言，21.6%（n=8）的病例为轻度出血，59.5%（n=22）为中度出血，18.9%（n=7）为重度出血。既往心脏病抗血小板治疗、抗凝治疗、DOAC 治疗、胰腺支架置入和结石清除使 ERCP 后出血的风险增加一倍。括约肌切开术使风险增加了五倍以上。
根据多变量分析，与接受华法林或低分子肝素（LMWH）抗凝治疗的患者相比，接受 DOAC 治疗的患者出血风险显著增加。
